In penetrating neck trauma, Zone II injuries (between the cricoid cartilage and the angle of the mandible) have traditionally been managed by mandatory surgical exploration. The current evidence-based approach most widely adopted is:

• A Selective surgical management guided by CT angiography and clinical assessment in haemodynamically stable patients ✓
• B Mandatory surgical exploration of all Zone II injuries regardless of haemodynamic status
• C Angioembolisation as first-line treatment for all Zone II vascular injuries
• D Expectant management with serial clinical examination only for Zone II injuries

Explanation

The traditional approach of mandatory surgical exploration of Zone II neck injuries has been replaced in most trauma centres by selective management. In haemodynamically stable patients without hard signs of injury (massive haemorrhage, expanding haematoma, air bubbling), CT angiography of the neck accurately identifies vascular and aerodigestive injuries, allowing selective operative or endovascular intervention only when indicated. Patients with hard signs of vascular injury still proceed directly to exploration. This approach reduces unnecessary explorations while maintaining diagnostic accuracy.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.